HomeMy WebLinkAbout1301 Blue Spruce Dr - Applications/Demolition - 02/25/2013Planning, Development & Transportation
City
}of 81 N. College Ave P.O. Box 580
FOI111CollinsiI IFort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPAcertified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applic tions will not be accepted.
Application # �J Ey 0 S Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1_L01 l.✓Q_ 1 $ 7-5o, UUo
Property Owner Name
Address
City/State
Zip
. Phone
Applicant Name
Address
City/State
Zip
Phone
Contractor Lic #
Address
City/State
Zip
Phone
I �n %ons�rt.t�io�g&q2,M:
;.A`�-A 6(1,hS lo
ft525
00,001855'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential PkCommercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Adical g%ffice ❑ Office ❑ Retail
❑ Restaurant Mther (explain) �;:>r �K
Is this building So years of age or more? O Yes '�Qlo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description ofwork-TI'S SW • '/�►'+ �� 8 3� 55.
TiL -wl C u S.-4A—_
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City
► o_fLFt Collins license
A#
Electrician N Waa G er-• Plumber I ` ` �" �'' ! Mechanical /�Y Roofer N /� Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: 4 _ _ A f ,
Print Name: OYSignature Date _